Justice Antonin Scalia's vote on King v. Burwellwas never a mystery. The only question was how ragey his dissent would be. The answer: very.But entertainingly so. Scalia repeatedly upbraids the six corrupt idiots of the majority for their failure to take health care from 6 million people over a minor error in drafting a law.

The Supreme Court has upheld the Obamacare subsidies for more than 6 million Americans with a 6-3 vote in the King v. Burwell decision, handed down moments ago.

which means: Obamacare passed Congress, despite death of a key Dem Senator in Mass and a Republican replacement, succeeded in a 2012 Supreme Court challenge (the 1st), was supported by the re-elected President, who made it a 2012 campaign issue, overcame obstacles to implementation in 2013 and '14, including Republican obstructionism and national and state levels, and now passes the Supreme Court again on a nuisance issue about enabling vocabulary.

There has been a theory, circulating in Washington's health policy circles for the past few weeks, that major insurer Aetna was scaling back its Obamacare marketplace plans in retaliation for the Obama administration blocking its proposed merger with Humana.Up until now, this was only a theory — one inferred from the timing of the blocked merger (in July) and Aetna souring on Obamacare (in August).Now there's proof.

Documents obtained by the Huffington Post show that Aetna expressly conditioned their marketplace participation on the merger's approval. The company threatened to "immediately ... reduce our 2017 exchange footprint" should the Obama administration challenge the deal.

I'm struggling to think of one positive lasting change Obama introduced in 8 years. And no, Obamacare does not rate - if he wasn't such a nice guy, I'd say it was a plot to stave off real public health care for another few generations, while lining the pockets of the insurance companies.

In Healing America, probably the best book ever written about how different countries provide universal healthcare, T.R. Reid explains that functioning systems have a huge variety of characteristics but several “standard building blocks” — and one is that “financing healthcare must be a nonprofit endeavor.”

As Reid writes, other countries have made it work with many different kinds of healthcare providers — doctors can work directly for the government, as in the U.K., or not, as in most other rich countries. Hospitals can be for-profit or not. But no one has been able to create a viable system of universal healthcare based on citizens being forced to help insurance companies make a profit.

Moreover, the political ramifications of non-profit healthcare financing go far beyond making it feasible to have a strong individual mandate to buy insurance. It also is a key reason why such systems have much lower costs: “When Aetna or WellPoint declines to pay for a drug or a procedure, the money saved goes to enhance the insurer’s profit, not to pay for another person’s treatment,” Reid points out. “So people are less willing to tolerate cost controls.”

So either Obamacare will include a universally-available, non-profit public option — which in turn would likely eventually become the only option — or it will eventually expire. There is no third way.

I really don't think Obamacare is any more than it seems on the surface. A collection of ad hoc measures which the Democratic Party could support, with the pious but foolish intention of improving access to health care while retaining the support of the health insurance industry, the health services industry, and the pharmaceutical industry. As such, it is very ugly and probably unviable, but not because the authors had anything further in mind. If they had wanted to bring in a public option, they had the votes in both houses in 2009-2011, but this wasn't what they wanted.

I think any government can only go so far in implementing measures that the public doesn't really want.

If you go back to when Canada implemented single-payer health care, or when Britain did, it's not like there weren't stable and powerful U.S. governments who could have just done the same thing. But I think that even some Americans* who would clearly benefit from such a thing continue to oppose it because it's not the self-sufficient American Way.

* and by that I mean some Tea Party Republican whose emergency health care fund is three twenties stuffed in a sock.

Very well. Do you believe that because of that support -- and I'm not even arguing with it -- even the Republicans would have said "oh well, it's what the people want"?

Even Chomsky seems to differentiate between what the people want and what their elected representatives want. And that discord does make for some interesting questions, though I think those questions should be asked by Republican supporters of single-payer and their Republican representatives.

Very well. Do you believe that because of that support -- and I'm not even arguing with it -- even the Republicans would have said "oh well, it's what the people want"?

Of course not, but no Republicans supported the law they did pass. They had the votes, they just didn't want to defy their owners.

Mr. Magoo wrote:

Even Chomsky seems to differentiate between what the people want and what their elected representatives want. And that discord does make for some interesting questions, though I think those questions should be asked by Republican supporters of single-payer and their Republican representatives.

Not even Chomsky, but especially Chomsky. He makes that point constantly. As did the recent statistical study from researchers at, I think, Princeton, which showed that only the wealthy have any influence whatsoever over legislation, and the wealthier you are, the more likely your opinions will be passed into law. As to the tangled motives of poorer Republican voters, books have been written about that subject.

I was walking up the hill towards Sherbrooke on a side street downtown (just south of McGill University) and saw a big sign "Private Medical Clinic" (actually it was in French, but you know...). I'm far from 16 any more, but a sudden urge came over me to find a brick or stone of some size and lob it in the window.

Private medical clinics are advertising on the radio here in Montreal. I heard one on 92.5. It is clear that the government of Quebec has encouraged this phenomenon. One thing they did was abolish annual checkups unless you have a 'chronic' condition. When I was in Ontario I looked into it for my daughter who was not getting the level of care she should have. They wanted $3500 a year plus specialist appointments which were $600 an hour. Fortunately we eventually found someone in the public system.

Do you feel that a necessary plurality of Americans actually wants the watch to work?

I'm not asking about this American or that American. Is there really a plurality that wants it to work?

Honestly, whenever we're discussing American health care and how regressive it is, I think of how they could fund the whole thing for the price of a few high-tech bombers, and I suddenly don't really care that badly, if they don't. Who am I to tell them what's really important?